ABSTRACT
BACKGROUND & AIMS: Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance. METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels. RESULTS: A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57-76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 [95% CI = 1.04-2.92], p = 0.036); severe malnutrition (OR 2.15 [95% CI = 1.16-4.35], p = 0.033); opiates (OR 1.97 [95% CI = 1.10-3.73], p = 0.036); and nausea/vomiting (OR 1.75 [95% CI = 1.04-2.94], p = 0.036). CONCLUSIONS: Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.
Subject(s)
Hyponatremia/epidemiology , Parenteral Nutrition, Total , Aged , Female , Humans , Male , Malnutrition , Middle Aged , Nausea , Parenteral Nutrition, Total/adverse effects , Parenteral Nutrition, Total/statistics & numerical data , Prospective Studies , Risk FactorsABSTRACT
Rhabdomyolysis may be secondary to trauma, excessive muscle activity, hereditary muscle enzyme defects and other medical causes. Primary hyperaldosteronism is characterised by hypertension, hypokalemia, suppressed plasma renin activity, and increased aldosterone excretion. Rhabdomyolysis is not common in primary hyperaldosteronism. We report here a 42-year-old woman presenting with rhabdomyolysis as heralding symptom of primary hyperaldosteronism. We also carried out a search of the literature to identify all cases of rhabdomyolysis as the first-recognized expression of a primary hyperaldosteronism. Sixteen cases met the criteria for inclusion. When rhabdomyolysis occurs in a patient with hypokalemia and metabolic alkalosis, primary hyperaldosteronism has to be suspected: if confirmed, an aldosterone-producing adenoma is the most probable cause.
